Letters

Cycling and health

Doctors should cycle and recommend it to their patients

Cyclists endanger pedestrians

Congratulations to Carnall

Why promote cycling?

Doctorsget on your bikes!

Schoolchildren cycle on the continent

You are what you drive

Doctors should cycle and recommend it to their patients

EDITORCarnall in his editorial is absolutely right about cycling.¹ Under the right conditions many more short journeys could be cycled. In some Dutch and Danish towns up to half of all journeys are made by bike; in the United Kingdom it is about 1% or 2% in most towns, with notable exceptions such as York and Cambridge (20%), whose traffic engineers have catered for cyclists.

Many people say they would cycle more if the roads were saferthe biggest deterrent to more cycling is high traffic speeds and volumes. There is obviously a vicious circle to be reversed here, and it is a shame that Prime Minister Tony Blair passed on his recent opportunity (the government's road safety and speed policy reviews) to introduce a national urban speed limit of 30 km/hour.

None the less, cycling is a lot safer than it looks: the health benefits outweigh the accident risks, and the average daily cyclist enjoys a degree of fitness equivalent to someone 10 years younger. Doctors would do well to bear this in mind when visited by unfit and overweight patients. Instead of prescribing diets and gym based exercise, they could prescribe walking or cycling, or both, for regular journeys to work, to the shops, or to take the children to school.

Cycling as part of a daily routine will save you money, save you time (you don't get stuck in the traffic jams), and add years to your life. Doctors should get out and do it more, then recommend it to their patients. Hey, you might even enjoy it!

Richard Evans, ETA Car Free Day co-ordinator. 
29 Somerset Avenue, Raynes Park, London SW20 0BJ richard{at}eta.co.uk

Cyclists endanger pedestrians

EDITORI have read Carnall's editorial on cycling with interest.¹ I am an advocate of accident prevention as well as health promotion. I abhor the appropriation of space by motorised vehicles and the murder of innocent people by speeding motorists. But I would not like to see any further increase in cycling, as it is dangerousnot for the cyclist, but for the pedestrian.

Cycling is a male dominated activity that mainly attracts youths and young men. They are mostly large, muscular, and powerful. Their attitude to safety is typical of their age and sex. It is well known that men take more risks and have four times as many accidents as women. They like speed and taking risks. Increasingly, they show this behaviour when cycling, whether on the pavement, in public parks, on pedestrian walkways, or in subwaysindeed, anywhere they see a route that is flat and unimpeded by traffic. Nor do they observe basic road drill. They speed round corners, jump pedestrian crossings, and use pedestrian refuges to cross the road. Legitimate users have no option but to jump clear. Accidents are avoided not by their care but by the vigilance of pedestrians.

Pedestrians are largely women, some elderly and some with children, toddlers, and infants. There are obviously some men, but they are mostly elderly. Women are smaller and may wear skirts that afford no protection to legs should they be hit. When walking, pedestrians have no means to see cyclists advancing from behind. Attention can easily be diverted. Children suddenly dart to the side, as do older people not expecting a cyclist to come hurtling up from behind.

But if a collision were to occur, the pedestrian could sustain injury that could prove fataland who would foot the bill? Cyclists are not obliged to carry third party insurance and carry no number plate for identification. The injured could be left disabled, unable to work, or dependent without compensation.

Although it is illegal to cycle on the pavement, cyclists shout abuse if reminded. There is no evidence that the police apply the law. Yes, if roads were safer cyclists might use them. But the solution is not for cyclists systematically to push pedestrians off the pavement and also foot tracks in parks or the countryside so that pedestrians can never walk without the risk of injury.

Christine Love, senior lecturer orthopaedic nursing. 
Faculty of Health Care Sciences, St George's Hospital Medical School, London, SW17 OQT clove{at}hcs.sghms.ac.uk

Congratulations to Carnall

EDITORIf people in the United Kingdom have good reasons to promote bicycle use,¹ you can imagine how important this is in poor countriesfor example, Brazil. Our bicycle project posted a message on a World Bank discussion list about poverty a couple of weeks ago arguing that improving bicycle infrastructure is a way out of poverty. We cited Roberts and part of his article published in the BMJ in 1999: "If the World Bank aims to reduce poverty and improve living standards by promoting sustainable growth and investment in people, it must do more to develop safe and sustainable transportation systems."²

We believe that poverty can be reduced by providing bicycle infrastructure and promoting bicycle use. Infrastructure for bicycles is a lot cheaper than that for cars, not to mention savings in terms of the environment and the health of the population. Yet we will need big efforts to change our traffic situation since Brazilian car drivers are much less educated than those from developed countries and have no respect for pedestrians or cyclists. Yet there are signs of hope: in March we participated in a meeting in the transport ministry. A study was presented about bicycle use in more than 60 Brazilian cities, and there was talk of restarting a pro-bicycle programme, after almost 20 years of silence.

Giselle Noceti Ammon Xavier, professor. 
CICLOBRASIL GroupSanta Catarina's State UniversityUDESC, 88085 700 Florianopolis, SC, Brazil Pedala Floripa project pedalafloripa{at}hotmail.com

Why promote cycling?

EDITORThe American philosopher Ralph Waldo Emerson wrote in the 19th century: "The civilized man has built a coach but has lost the use of his feet." The cave dweller's natural desire for exercise has been replaced by the city dweller's desire to pump the gas pedal. Recently, we have finally recognised the environmental and medical consequences of this, as made clear by Carnall in his editorial on cycling.¹

Studies have shown that 2000 kcal of weekly exercise is desirable, but doctors tend to recommend much less, sometimes as little as 15 minutes three days a week, if they recommend exercise at all.

A recent study has found that 2800 kcal a week of exercise helps control weight better.² In addition, Scientific American has reported that the average person worldwide spends 66 minutes per day travelling, whether walking, bicycling, or using motorised transport.³ I think these 66 minutes represent the natural amount of daily exercise we should be achieving.

But, as busy as people are, how can they find time each day for 66 minutes of exercise? I accomplish it by riding my bike to work. Little extra time is involved, the trip is more enjoyable, and I even save money. I therefore agree with the stance taken by Carnall. If doctors ride bikes to work, they will not only set a good example for their patients but will also get the health benefit they need as well.

Ken Kifer, part-time English instructor. 
Gadsden State Junior College, Alabama 35904, USA kenkifer{at}kenkifer.com

Doctorsget on your bikes!

EDITORWith reference to Carnall's editorial on cycling and health promotion,¹ biking can also have the advantage of bringing you closer to the people on the street, in my case the patients attending the Edinburgh Homeless Practice. Because I am in the open and slow I see more, I hear more, I smell more. That contributes to a greater understanding of the world our patients live in. Occasionally, I also talk more, having a chat with a patient on the street.

Helga Rhein, general practice consultant. 
Edinburgh Homeless Practice, Edinburgh EH1 3AT h.rhein{at}telemedicine.clh.ed.ac.uk

Schoolchildren cycle on the continent

EDITORI have read the responses to Carnall's editorial on cycling.¹ None of your correspondents mentions the factor I believe to be most important in encouraging my age group to cycleseparate cycle carriageways. I have just returned from an exchange trip to Munich, Germany, with a mixed group of 18 students from Leeds, aged 15. None of these students currently dares use a bicycle to travel to school, to friends' houses, or into town. However, when in Munich we all had lots of opportunities to cycle. All of the roads had segregated cycle paths, separate from both cars and pedestrians. I have also seen this sort of provision for cyclists in Denmark.

The German teenagers' parents had no problems letting them take their bikes out for the day, knowing they would be safe on their journeys. This gives my age group much wanted freedom and exercise.

Even if speed limits were reduced to 30 km per hour (enforced at 40 km per hour), would you let your teenager out for the day on a bike in the majority of cities and towns in the United Kingdom? I can see an increase in the number of teenagers wanting to (and being allowed to) use their bikes for transport only if separate carriageways are introduced. These do not include the pathetic painted cycle paths currently offered in Leeds where the roads are reasonably wide, which inevitably disappear when you really need them. Could we send our transport planners and the transport minister, John Prescott, to Denmark or Germany to see how it is done?

Zohra Chiheb, high school student. 
9 Montagu View, Leeds LS8 2RH Booicancu{at}aol.com

You are what you drive

EDITORI agree with Carnall that you are what you drive.¹ I'm a slimmed down, stop on a sixpence, nought to 20 in about a minute, bright green mountain bike. I'm well adapted for country and town, never known to shrink in the rain, enjoying the sun on my face and on my back. I'm nippy and fit, and most mornings and evenings I'm on top of the world.

Why can't we hijack the advertising? Yes, you are what you drive, but this is only really true if you drive a bicycle.

Ian Wacogne, paediatric registrar. 
Royal Children's Hospital, Brisbane, Queensland 4029, Australia wacogne{at}hotmail.com